Difference between revisions of "Nephroureterectomy grossing"

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==Introduction==
==Introduction==
Nephrectomies are often done for [[urothelial carcinoma]].
Nephrectomies are often done for [[urothelial carcinoma]].  
 
The false positive/negative for tumour rate is reported as high as 2.9%.<ref name=pmid25408605>{{Cite journal  | last1 = Hong | first1 = S. | last2 = Kwon | first2 = T. | last3 = You | first3 = D. | last4 = Jeong | first4 = IG. | last5 = Hong | first5 = B. | last6 = Hong | first6 = JH. | last7 = Ahn | first7 = H. | last8 = Kim | first8 = CS. | title = Incidence of benign results after laparoscopic radical nephroureterectomy. | journal = JSLS | volume = 18 | issue = 4 | pages =  | month = Oct | year = 2014 | doi = 10.4293/JSLS.2014.00335 | PMID = 25408605 }}</ref>


==Specimen opening==
==Specimen opening==

Revision as of 16:30, 28 November 2014

This article deals with the cut-up of nephroureterectomy specimens which include both a kidney and a ureter.

Total nephrectomy specimens (without the ureter) and partial nephrectomy specimens are dealt with separately.

Introduction

Nephrectomies are often done for urothelial carcinoma.

The false positive/negative for tumour rate is reported as high as 2.9%.[1]

Specimen opening

  1. Paint surface of specimen (optional).
  2. Take the vascular margins - renal artery and renal vein (both en face) and place in one tissue cassette.
  3. Open the kidney in the frontal plane (from lateral to medial).
    • The cut should go through the renal pelvis.

Protocol

Dimensions, weight and inking:

  • Type: nephroureterectomy.
  • Laterality: [left / right].
  • Weight: ___ grams.
  • Size of specimen (superior-inferior, left-right, anterior-posterior): ___ x ___ x ___ cm.
  • Ureter (length x diameter): ___ x ___ cm.
  • Size of bladder cuff: ___ x ___ cm.
  • Renal vein (length x diameter): ___ x ___ cm.
  • Renal artery (length x diameter): ___ x ___ cm.
  • Adrenal gland: [___ x ___ x ___ cm / not identified].
  • Inking of surface: [colour].
  • Size of kidney (superior-inferior, left-right, anterior-posterior): ___ x ___ x ___ cm.
  • Perinephric fat (maximal dimension): ___ cm.

Tumour:

  • Dimensions (superior-inferior, left-right, anterior-posterior): ___ x ___ x ___ cm.
  • Location: [upper pole / lower pole / renal pelvis / ureter].
  • Colour: [white / tan / yellow].
  • Morphology: [solid / cystic / solid and cystic - with ___ % cystic].
  • Friability: [friable / not friable].
  • Circumscription: [well circumscribed / indeterminate / infiltrative border].
  • Hemorrhage: [present / absent].
  • Necrosis: [present / absent].
  • Margin: [nearest margin ___, distance ___ cm / positive margin, location ___].
  • Extension into perinephric fat: [absent / not identified-pushing border / suspicious / present].
  • Extension into the renal parenchyma system: [absent / suspicious / present].
  • Extension into renal sinus fat: [absent / not identified-pushing border / suspicious / present].
  • Extension into renal vein: [absent / suspicious / present].

Other:

  • Non-tumour renal parenchyma: [cortex unremarkable / thinned].
  • Non-tumour collecting system mucosa: [smooth and regular / granular / irregular / dilated].
  • Lymph nodes: [number of lymph nodes with [unremarkable cut surface / tumour] / not identified].

Representative sections are submitted:

  • Renal vein margin and renal artery margin (en face)
  • Urinary bladder cuff margin (en face).
  • Urinary bladder cuff.
  • Ureter - representative sections.
  • Tumour with nearest margin.
  • Tumour in relation to perinephric fat. †
  • Tumour in relation to renal parenchyma. ††
  • Tumour and sinus fat.
  • Normal kidney.
  • Adrenal gland.

Protocol notes

  • † This typically upstages to pT4. It is uncommon that the tumour goes through the kidney and into the perinephric fat.
  • †† Invasion into the renal parenchyma typically upstages to pT3. This can be difficult to judge on cut-up. If renal parenchymal invasion is not seen grossly at least three sections should be taken.

Alternate approaches

See also

Related protocols

References

  1. Hong, S.; Kwon, T.; You, D.; Jeong, IG.; Hong, B.; Hong, JH.; Ahn, H.; Kim, CS. (Oct 2014). "Incidence of benign results after laparoscopic radical nephroureterectomy.". JSLS 18 (4). doi:10.4293/JSLS.2014.00335. PMID 25408605.